When we get in, since the breast tissue is constricted, we’re going to cut it in five places and we’re going to do it both here on this one and closer to the nipple areola complex on this one. And at the same time as we’re doing that, we’re also going to do a transaxillary approach for a breast augmentation so that we can decide what breast fits the best for her. The reason we’re doing a periareolar incision here is to keep the two nipples the same size. That’s number one. And number two, she doesn’t like her pouty nipples and so therefore we’re going to get rid of those using the dermal anchor suture, which is a means of anchoring or tightening the dermis so the nipples aren’t pouty. Then we mark it with a 38mm cookie cutter on stretch. Next, we go into the armpit using a curved stevens scissor just to get some relaxation to get in. Now we put the endoscope in this space, over the pec minor, under the pec major.
Pectoralis muscle is still in tact, but we’re moving it off the fifth rib. We certainly do not want to detach the pec from the sternum. It’s pretty soft, pretty good. Ok, let’s cut our new areola. This tissue, see she really has no breast tissue on the bottom. She has a reasonable amount on top, lots of top breast tissue, but hardly any on the bottom and because of that what little she has is constricted and so we have to make cuts into it to allow it to expand. We are going to lower the fold a little bit which we wouldn’t have been able to do with the normal, tight tuberous breast. And we’re going to get the implant down, and on this side it’s not willing to go down so we’ll figure out what is in the way inhibiting it. Then we’re going to tailor-tack and match the two sides. And that’s about what we’re going to do.
Let’s start with the more difficult one first. We’ve got no active bleeding. Is there anything inhibiting movement here? Dermal anchors, now this is the stitch that gets rid of pouty nipples. We’re going to take it from the dermis and anchor it down to the deeper tissue so we’re getting a 3-dimensional stitch. Most of the other sutures are in 2 dimensions, there are 3 of these. And this seems to, at least in my experience, has corrected pouty nipples 100% of the time. We actually create some infra-areolar tissue even though it didn’t exist pre-operatively.
And there we are. Beautiful. Looks great. She will love it. We’ve gotten rid of the fat in the axilla, we’ve gotten rid of the pouty nipple, we’ve gotten rid of the short distance from the inframammary fold to the nipple. Sew in our drain, now, ok, level her out.